Dental appliance sequence ordering system and method

ABSTRACT

The present invention provides systems and methods for providing dental appliances, particularly orthodontic appliances, to a patient wherein the patient is easily able to determine the order or sequence in which the appliances should be worn. Typically the appliances are to be worn in a particular sequence to provide desired treatment, such as a progressive movement of teeth through a variety of arrangements to a final desired arrangement.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.10/612,239 (Attorney Docket No. 018563-006700US), filed Jul. 1, 2003,and related to divisional U.S. patent application Ser. No. 11/285,707(Attorney Docket No. 018563-006710US), filed Nov. 21, 2005, the fulldisclosures of each of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention is related generally to the field of orthodontics.More particularly, the present invention is related to methods andsystems for dispensing a series of orthodontic appliances in a sequenceto a patient.

Repositioning teeth for aesthetic or other reasons is accomplishedconventionally by wearing what are commonly referred to as “braces.”Braces comprise a variety of appliances such as brackets, archwires,ligatures, and O-rings. Attaching the appliances to a patient's teeth isa tedious and time consuming enterprise requiring many meetings with thetreating orthodontist. Consequently, conventional orthodontic treatmentlimits an orthodontist's patient capacity and makes orthodontictreatment quite expensive. Moreover, from the patient's perspective, theuse of braces is unsightly, uncomfortable, presents a risk of infection,and makes brushing, flossing, and other dental hygiene proceduresdifficult.

As a result, alternative methods and systems for repositioning teethhave been developed. For example, repositioning may be accomplished witha system comprising a series of appliances configured to receive theteeth in a cavity and incrementally reposition individual teeth in aseries of at least three successive steps. Most often, the methods andsystems reposition teeth in from ten to twenty-five successive steps,although complex cases involving many of the patient's teeth may takeforty or more steps. The individual appliances are typically comprisedof a polymeric shell having the teeth-receiving cavity formed therein,typically by molding. The successive use of a number of such appliancespermits each appliance to be configured to move individual teeth insmall increments.

Typically the systems are planned and all individual appliances arefabricated at the outset of treatment. Thus, the appliances may beprovided to the patient as a single package or system. The order inwhich the appliances are to be used can be marked by sequentialnumbering directly on the appliances or on tags, pouches or other itemswhich are affixed to or which enclose each appliance so that the patientcan place the appliances over his or her teeth in an order and at afrequency prescribed by the orthodontist or other treating professional.Successive appliances will be replaced when the teeth either approach(within a preselected tolerance) or have reached the target endarrangement for that stage of treatment, typically being replaced at aninterval in the range from 2 days to 20 days, usually at an interval inthe range from 5 days to 10 days.

In general, it is preferable to simplify procedures for the patient toincrease patient compliance and reduce patient errors in carrying outthe treatment protocol. Therefore, it is desirable to utilize apackaging or ordering system which will provide appliances to a patientin a manner which is clearly discernable to the patient the order of theappliances. In addition, such packaging or ordering system should beamenable to mid-treatment changes to the treatment protocol, possiblyadding or eliminating appliances after the initial set of appliances hasbeen produced and packaged. At least some of these objectives will bemet by the methods and systems of the present invention describedhereinafter.

2. Description of the Background Art

Tooth positioners for finishing orthodontic treatment are described byKesling in the Am. J. Orthod. Oral. Surg. 31:297-304 (1945) and32:285-293 (1946). The use of silicone positioners for the comprehensiveorthodontic realignment of a patient's teeth is described in Warunek etal. (1989) J. Clin. Orthod. 23:694-700. Clear plastic retainers forfinishing and maintaining tooth positions are commercially availablefrom RAINTREE ESSIX, INC., New Orleans, La. 70125, and TRU-TAINPLASTICS, Rochester, Minn. 55902. The manufacture of orthodonticpositioners is described in U.S. Pat. Nos. 5,186,623; 5,059,118;5,055,039; 5,035,613; 4,856,991; 4,798,534; and 4,755,139.

Other publications describing the fabrication and use of dentalpositioners include Kleemann and Janssen (1996) J. Clin. Orthodon.30:673-680; Cureton (1996) J. Clin. Orthodon. 30:390-395; Chiappon(1980) J. Clin. Orthodon. 14:121-133; Shilliday (1971) Am. J.Orthodontics 59:596-599; Wells (1970) Am. J. Orthodontics 58:351-366;and Cottingham (1969) Am. J. Orthodontics 55:23-31.

BRIEF SUMMARY OF THE INVENTION

The present invention provides systems and methods for providing dentalappliances, particularly orthodontic appliances, to a patient whereinthe patient is easily able to determine the order or sequence in whichthe appliances should be worn. Typically the appliances are to be wornin a particular sequence to provide desired treatment, such as aprogressive movement of teeth through a variety of arrangements to afinal desired arrangement.

In a first aspect of the present invention, a system of dentalappliances is provided comprising a plurality of dental applianceswherein at least some of the plurality include a non-numeric indiciadesignating an order in which each of the at least some of the pluralityare to be worn by a patient to provide dental treatment. Typically, eachof the plurality of dental appliances comprise a polymeric shell havingcavities shaped to receive and resiliently reposition teeth from onearrangement to a successive arrangement. Exemplary embodiments of suchdental appliances are described in U.S. Pat. No. 5,975,893, incorporatedherein by reference for all purposes. In some embodiments, each of thepolymeric shells has at least one terminal tooth cavity and the indiciacomprises a terminal tooth cavity of differing length in each of thepolymeric shells. In other embodiments, each of the polymeric shell hasa height and the indicia comprises a different height in each of thepolymeric shells.

In still other embodiments, the indicia comprises one or more cutouts sothat each polymeric shell has a different cutout pattern. Sometimes thecutout comprises a notch in an edge of the appliance.

In yet other embodiments, the indicia comprises a color wherein eachappliance has different color. The color of the appliances may have thesame hue and vary by intensity, for example. The color may comprise adissolvable dye. Or, the system may further comprise a wrapper removablyattachable to each of the appliances, wherein each wrapper has thecolor.

In another aspect of the present invention, a system of packaged dentalappliances is provided comprising a plurality of packages eachcontaining a dental appliance, wherein the plurality of packages arejoined in a continuous chain designating an order in which each of thedental appliances are to be worn by a patient to provide dentaltreatment. In some instances, the packages are each joined by aperforation wherein the packages can be separated by breaking theperforation. In other instances, the packages are joined by, forexample, a heat seal. Further, the system may include a marking on apackage at an end of the chain indicating the dental appliance to beworn first. Again, each of the plurality of dental appliances maycomprise a polymeric shell having cavities shaped to receive andresiliently reposition teeth from one arrangement to a successivearrangement.

In a further aspect of the present invention, a system of dentalappliances is provided comprising a plurality of dental appliances to beworn by a patient to provide dental treatment, and a framework, whereineach of the plurality of dental appliances are removably attached to aportion of the framework. In some embodiments, each of the plurality ofdental appliances comprise a polymeric shell having cavities shaped toreceive and resiliently reposition teeth from one arrangement to asuccessive arrangement. Further, the system may comprise at least onemarking on the framework indicating the order in which the appliancesare to be worn by a patient.

In still another aspect of the present invention, method of dispensingdental appliances to a patient is provided. The method including thestep of providing a plurality of packages wherein each of the packagesincludes a polymeric shell having cavities shaped to receive andresiliently reposition teeth from one arrangement to a successivearrangement, the plurality of package including a first packagecontaining a first shell to be worn by the patient to reposition theteeth from the one arrangement to the successive arrangement and asecond package containing a second shell to be worn by the patient toreposition the teeth from the successive arrangement to anothersuccessive arrangement. The method further including the steps ofdelivering the first package to the patient at a designated time througha remote delivery system, and delivering the second package to thepatient at a later designated time through the remote delivery system.In most embodiments, the remote delivery system comprises a maildelivery system.

In another aspect of the present invention, a method is provided ofdispensing dental appliances to a patient including providing adispenser including a plurality of dental appliances, wherein each ofthe appliances comprises a polymeric shell having cavities shaped toreceive and resiliently reposition teeth from one arrangement to asuccessive arrangement, the plurality of appliances including a firstshell to be worn by the patient to reposition the teeth from the onearrangement to the successive arrangement and a second shell to be wornby the patient to reposition the teeth from the successive arrangementto another successive arrangement, and removing the first shell from thedispenser wherein removal of the first shell dispenses the second shell.

In a further aspect of the present invention, a method of dispensingdental appliances to a patient is provided including providing adispenser including a plurality of dental appliances, wherein each ofthe appliances comprises a polymeric shell having cavities shaped toreceive and resiliently reposition teeth from one arrangement to asuccessive arrangement, the plurality of appliances including a firstshell to be worn by the patient to reposition the teeth from the onearrangement to the successive arrangement and a second shell to be wornby the patient to reposition the teeth from the successive arrangementto another successive arrangement. The method further includes removingthe first shell from the dispenser, and actuating an actuator thatsubsequently dispenses the second shell. In most embodiments, theactuator comprises a lever, knob, or button.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic illustration of a series of appliances dispensedin a chain.

FIG. 2 illustrates a series of appliances disposed on a framework.

FIG. 3 illustrates a series of appliances provided to a patient in adispenser.

FIGS. 4A-4B illustrate a change in length of a terminal tooth cavitybetween appliances in a series.

FIGS. 5A-5B illustrate a change in height between appliances in aseries.

FIGS. 6A-6B illustrate the addition of cutouts in each appliance toindicate an order.

FIGS. 7A-7C illustrate a change in color to indicate an order.

FIG. 8 illustrate an embodiment of a method of delivering appliances ina desired order.

FIG. 9 illustrates an appliance which includes a readable elementembedded in the appliance.

FIG. 10 illustrates a series of packages 12, each having a label whichincludes at least one non-numeric indicia.

FIG. 11 illustrates a package of dental appliances of the presentinvention.

DETAILED DESCRIPTION OF THE INVENTION

It may be appreciated that the orthodontic appliances may be dispensedto the patient in its entirety, in groups or individually. Providing thepatient with the entire series at the outset of treatment may bedesirable if the treatment plan is relatively short, the patient isparticularly compliant, or it is particularly convenient, to name a few.In this case, the series should be ordered so that the patient caneasily selected the next appliance in the sequence when needed. Suchordering may be designated through packaging or the appliance itself. Insome situations, the patient may receive additional appliances duringthe treatment protocol for inclusion in the sequence and/or the patientmay receive instructions to eliminate some of the original appliancesfrom the treatment protocol. Therefore, such ordering should allow easyincorporation of additional appliances or deletion of appliances.

Alternatively, the patient may be provided with a subset of the entireseries, such as the first ten appliances. In this case, the subsetshould be ordered so that the patient can easily selected the nextappliance in the sequence when needed. Again, such ordering may bedesignated through packaging or the appliance itself. The patient mayreceive additional appliances during the use of the subset for inclusionin the sequence and/or the patient may receive instructions to eliminatesome of the original appliances from the subset. Alternatively, the nextsubset of appliances may differ from that which was initial determinedat the outset of the treatment protocol. Therefore, such ordering shouldallow easy incorporation of additional appliances or deletion ofappliances within or between subsets.

Further, the patient may be provided with individual appliances in theorder in which they should be used. In this case, the appliances shouldbe ordered so that the patient can easily differentiate the appliancethey are receiving from the appliances already received. Again, suchordering may be designated through packaging or the appliance itself. Inaddition, such ordering should allow the appliances to be stored anddistributed to the patient in the correct sequence with minimalattention from the orthodontic practitioner.

A variety of embodiments of ordering systems and methods will bedescribed. In a first embodiment, a series of appliances are dispensedto the patient in a continuous chain, wherein the appliances are to beused in the sequence of the chain. An example of such a chain isschematically illustrated in FIG. 1. Here, each appliance 10 is disposedwithin a package 12, wherein the packages 12 are joined together in acontinuous chain. In this embodiment, each package 12 is separable at aperforation 14 from the remaining packages 12 in the chain. It may beappreciated that the packages may be joined and/or are separable in anysuitable manner including with the use of adhesives, heat sealing,ultrasonic welding, linkages or simply indications where to cut, breakor separate, to name a few. To indicate the end of the chain in which itbegin use, a marking may be located on the package 12 or on theappliance 10. For example, a colored marking 16 may be located on an endpackage 12 a, as shown. This would indicate that a first appliance 10 ais enclosed. Once the first appliance 10 a has been removed from thepackage 12 a and worn for a given amount of time, the patient may thenopen a next package 12 b in the chain and remove a second appliance 10 bfor wearing. This may be repeated throughout the chain.

In another embodiment, illustrated in FIG. 2, a series of appliances 10are disposed on a framework 20, such as a sprue. Sprues typically secureobjects, such as molded objects, before their first use. The appliances10 are secured to the framework 20 in any suitable manner. Theappliances 10 are then removed from the framework 20 according to atreatment protocol. For example, the first appliance 10 a to be used maybe disposed at one end of the framework 20, the second appliance 10 bdisposed next to the first appliance 10 a, the sequence continuing alongthe framework 20. Alternatively or in addition, markings may be disposedon the framework 20 or the appliances 10 themselves indicating anordering of use.

In another embodiment, illustrated in FIG. 3, a series of appliances 10are provided to a patient in a dispenser 30. The dispenser 30 dispensesthe appliances 10 in the order to be used. Each appliance 10 may beindividually dispensed, as shown, or each appliance 10 may be containedin a package wherein the packages are individually dispensed. Thedispenser 30 may include an actuator 32, such as a lever, button,switch, etc, so that actuation of the actuator 32 dispenses theappliance 10 or package containing the appliance 10. Alternatively,removal of an appliance 10 from the dispenser 30 may actuate dispensingof the next appliance 10. In this way, the patient is systematicallydispensed appliances in a predetermined order of use.

In some situations it may be desired to specifically mark the appliancesthemselves. Such markings ensure that ordering of the appliances isdistinguishable after removal of the appliances from any packaging andduring use. For example, a portion of each appliance may be changed toindicate a sequence or order. FIGS. 4A-4B illustrate a change in lengthof the appliance 10 by changing the length of a terminal tooth cavity40. A terminal tooth cavity 40 is one of the last teeth in theappliance. FIG. 4A illustrates a first appliance 10 a wherein a markedterminal tooth cavity 40 a has a given length. FIG. 4B illustrates asecond appliance 10 b wherein a marked terminal tooth cavity 40 b has alength which differs from the first appliance 10 a. Here, the markedterminal tooth cavity 40 b has a shorter length. The lengths cancontinue to differ throughout the sequence of appliances. Alternativelyor in addition, the lengths of other terminal teeth may differ.

FIGS. 5A-5B illustrate a change in the height of each appliance 10 toindicate a sequence or order. The height of the appliance 10 is thedistance from the occlusal surfaces 46 to the edges 48 of the appliance10. FIG. 5A illustrates a first appliance 10 a having a given height.FIG. 5B illustrates a second appliance 10 b having a height whichdiffers from the first appliance 10 a. Here, the second appliance 10 bhas a shorter height. The heights can continue to differ throughout thesequence of appliances indicating an order. It may be appreciate thatthe overall height of the appliance may differ or the height of specificportions of the appliance may differ through the sequence.

FIGS. 6A-6B illustrate the addition of notches or cutouts 56 in eachappliance 10 to indicate a sequence or order. The cut outs may be of anysize, shape, orientation, or number forming any pattern. Further, thecut outs may be located on an edge 48 of the appliance 10 or on anysurface, including an occlusal surface 46. FIG. 6A illustrates a firstappliance 10 a having a first cut out 56 a. The first cut out 56 a has arectangular shape and is located near an edge 48. FIG. 5B illustrates asecond appliance 10 b having a second cut out 56 b so that the cut outpattern of the first appliance 10 a differs from that of the secondappliance 10 b. Here, the second cut out 56 b also has a rectangularshape and is located near the edge 48 adjacent to the first cut out 56a. The cut out patterns can continue to differ throughout the sequenceof appliances indicating an order.

FIGS. 7A-7C illustrate a change in color, such as a hue, gradation ofhues, shade, tint or intensity, for each appliance 10 to indicate asequence or order. For example, the appliances 10 may appear darker orlighter in color through the series, such as ranging from dark red tolight pink or vice versa. Or, the sequence may follow the color of therainbow, such as red, orange, yellow, green, etc. Or, the sequence mayfollow any other prescribed order of colors. FIG. 7A illustrates a firstappliance 10 a having a first color 60 a. FIG. 7B illustrates a secondappliance 10 b having a second color 60 b so that the color of the firstappliance 10 a differs from that of the second appliance 10 b. The colorchanges can continue to differ throughout the sequence of appliancesindicating an order. It may be appreciated that the appliances 10 a, 10b may have the color over their entirety, as shown, or the appliancesmay be colored in some areas and not in others. Or multiple colors maybe used on a single appliance, such as in stripes, blocks or variousshapes. The color may be embedded in the appliance, such as with the useof a colored plastic rather than the typical clear plastic. Or, thecolor may be in the form of a dissolvable dye which dissolves in contactwith air, such as upon removal from a package, or contact with liquid,such as when rinsed with water or placed in the patient's mouth.Alternatively, as illustrated in FIG. 7C, the color may be present in apeel-away wrapper 62. The colored wrapper 62 may be attached to theappliance 10 by lamination or other methods. In this example, thewrapper 62 covers the occlusal surfaces 46 of the appliance 10, howeverany portion of the appliance 10 may be covered. When the appliance 10 isto be used, the wrapper 62 is peeled away, as shown, and removed. Inthis way, the appliances may be ordered by color but worn in atransparent state.

Alternatively or in addition, the patient may be provided withindividual appliances in the order in which they should be used. Toprovide such ordering while allowing the appliances to be stored anddistributed to the patient in the correct sequence with minimalattention from the orthodontic practitioner, a method may be used inwhich the appliances are delivered by mail in a specific sequence. FIG.8 illustrates an embodiment of such a method. As shown, the appliances10 are individually packaged so that a first package 80 contains a firstappliance, a second package 82 contains a second appliance, a thirdpackage 84 contains a third appliance, etc. The packages 80, 82, 84 aresent through the mail or any delivery system so that they are deliveredto the patient P according to a desired schedule. For example, the firstpackage 80 is delivered to the patient P at day 1, the second package 82is delivered at day 7, the third package 84 is delivered at day 14, etc.It may be appreciated that the individual packages may alternatively becomprises of series of appliances, such as subsets of the entire seriesof the treatment plan. In such a case, the patient P is delivered apackage of appliances 10 at each interval, wherein each package includesa series of appliances. The series may itself also be ordered by anygiven system, including any of those mentioned above.

FIG. 9 illustrates one appliance 10 of a series of appliances whereinthe appliance 10 includes a readable element 100 embedded in theappliance 10. Alternatively, the readable element 100 may be affixed tothe appliance 10 or to a package enclosing the appliance. The readableelement 100 may comprise a chip, a bar code or other element that iscomputer readable, including identification by wireless means, includingradiofrequency (rf) identification. When a reader 102 passes over theelement 100, the reader 102 translates the information into a word,symbol or other identifying feature. When translated into a word, theword may include, “first”, “second”, “third”, or “last” to name a few.Also, the word may be in any language, including English, Spanish,French, German, Japanese, etc. The word or identifying feature may beauditory, such as a recording or generation of a spoken voice, orvisual, such as a print display. Alternatively, the feature may betransmitted by tactile means, such as by vibration.

FIG. 10 illustrates a series of packages 12, each package 12 includingat least one appliance 10. Affixed to or incorporated in each package 12is a label 100. The label 100 includes at least one non-numeric indicia.For example, a first package 102 shows a label 100 having a series ofnumbers wherein one number is marked, in this case stamped with acolored dot 103. This indicates which appliance 10 the first package 102contains in the treatment sequence. It may be appreciated that thenumber can be marked with any symbol by any method, including removingthe number by erasure, punch-out or notching. It may also be appreciatedthat other symbols may be used other than numbers, wherein one of thesymbols is marked. This is illustrated in a second package 104 whichshows such a label 100. A third package 106 shows a label 100 having aseries of symbols, such as shapes, in this case, triangles 120. Thesymbols themselves or the color, number, or arrangement may indicatewhich appliance 10 the third package 106 contains in the treatmentseries. It may be appreciated that such symbols may include stripes, asillustrated on a fourth package 108 which shows such a label 100. Thestripes may be human readable or computer readable, such as a barcode.

FIG. 11 illustrates an embodiment of a package of dental appliancescomprising a package 12 including a plurality of dental appliances 10positioned in an arrangement within the package 12 which indicates anorder of usage. In this embodiment, the arrangement comprises stackingof the appliances.

Although the foregoing invention has been described in some detail byway of illustration and example, for purposes of clarity ofunderstanding, it will be obvious that various alternatives,modifications and equivalents may be used and the above descriptionshould not be taken as limiting in scope of the invention which isdefined by the appended claims.

1. A system of packaged dental appliances comprising: a plurality ofpackages each containing a dental appliance having cavities shaped toreceive and resiliently reposition teeth from one arrangement to asuccessive arrangement, wherein the plurality of packages are joined ina continuous chain designating an order in which each of the dentalappliances are to be worn by a patient to provide dental treatment, andwherein the plurality comprises a non-numeric, non-alpha-numeric indiciaon a package at an end of the chain, the indicia comprising informationindicating a dental appliance to be worn first.
 2. A system as in claim2, wherein the packages are each joined by a perforation wherein thepackages can be separated by breaking the perforation.
 3. A system as inclaim 3, wherein the packages are joined by a heat seal.
 4. A system ofpackages for dental appliances, comprising: a plurality of packages,each package of the plurality configured for housing at least one dentalappliance, each of the dental appliances having cavities shaped toreceive and resiliently reposition teeth from one arrangement to asuccessive arrangement, wherein each package includes a label having anon-numeric, non-alpha-numeric indicia comprising information indicatingthe order of usage of the corresponding dental appliance, and wherein apackage includes a non-numeric, non-alpha-numeric indicia comprisinginformation identifying a first dental appliance in the order of usage.5. A system as in claim 4, wherein the label includes a series ofnumbers and the non-numeric, non-alpha-numeric indicia comprises amarking on one of the numbers, wherein the marking indicates order ofusage of the corresponding dental appliance.
 6. A system as in claim 4,wherein the label includes a series of numbers and the non-numeric,non-alpha-numeric indicia comprises a removal of one of the numbers,wherein the removal indicates order of usage of the corresponding dentalappliance.
 7. A system as in claim 6, wherein the removal of one of thenumbers comprises a holepunch.
 8. A system as in claim 4, wherein thenon-numeric, non-alpha-numeric indicia comprises at least one shape,wherein the shape indicates order of usage of the corresponding dentalappliance.
 9. A system as in claim 8, wherein the at least one shapecomprises at least one stripe.
 10. A system as in claim 9, wherein theat least one stripe comprises a series of stripes forming a barcode.